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FOX DRUG STORE
DSH050196 Central Valley General Hospital
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Covered Entity Details
Entity Name
Central Valley General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050196
Entity Address
1025 N. Douty Street
Hanford, CA 93230
Medicare Provider Number
050196
Participating Start Date
1/1/2008
Last Recertification Date
8/17/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
FOX DRUG STORE
Pharmacy Address
13660 E MANNING AVE STE 102
PARLIER, CA 93648-9743
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Wayne Ferch, President & CEO
(559) 537-0053
Contract Pharmacy Representative
Sunnyside Pharmacy
Lunny Jung, CEO
(213) 590-2375
Signed By Date
4/15/2013
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